Long-term care providers ready to deal with 'doc fix'

If you hang around long enough, you learn there are only two things long-term care providers fear after Republicans and Democrats. That would be hospitals and doctors.

Why the bother over these frequent partners in care? Simple: Uncle Sam has only so much money in his sack and nursing homes get their share only after hospitals and docs are taken care of. (That's a good mapping how your basic Accountable Care Organization hierarchy will play out, too, but that's a post for another day.)

Make no mistake: Hospitals and docs work hard to gain all that influence. It's not easy raising all those millions of dollars to put into lawmakers' favorite causes. Nursing homes do well in their own right with fund-raising, but they are still dwarfed by the physician lobby, which in turn is dwarfed by the hospital lobby.

So nursing home operators' fear is not misplaced. That's why a certain press release Tuesday from the American Health Care Association came as little surprise: “Skilled nursing providers prepare for Doc Fix Proposals.” Anxiety hung between the lines like thick grease. The release was timed for the same day as a Senate Finance Committee hearing exploring options for dealing with the so-called “doc [pay] fix.”

“We hope Congress can devise these solutions without looking to long-term and post-acute care providers as a ‘pay-for,'” said AHCA President and CEO Mark Parkinson. “Tapping one group of providers to assist another doesn't strengthen the system.”

LTC lobbyists, however, seem to have been preparing themselves for this. They seem almost resigned to the fact that something has to give and it's liable to be a part of their funding. In a textbook case of trying to make lemonade out of possible lemons, however, the LTC lobby is demanding a “therapy cap fix” to go with any “doc fix.”

That could certainly take the sting out of a physician's needle to the LTC arm.

As for Tuesday's Finance Committee hearing, it was a mixed bag, with no obvious saving lines. While some naively called for a freeze of physician pay rates, others made silly proposals to diminish the Sustainable Growth Rate, which currently calls for something like a 30% pay cut for Medicare doctors. While that is, and has been, beyond the realm of the doable, long-term care stakeholders still know that someone always will have to come up with dough for docs. It is going to be hard to give physicians their desired increase without taking back somebody else's funding.

That's where long-term care's insecurities come into play. The good news is the LTC client base will be powerful for many years into the future. There's no getting around the boom. It might be the strongest leverage LTC providers have.